The Face of Urban Poverty

Girl crossing the street in Karari, Korogocho. Photo by Amy Hart

When it comes to urban health, an African slum is where the rubber really meets the road ??? or more realistically, the filthy dirt path lined with putrid streams and muddy puddles of yesterday’s rain teeming with the human waste of 250,000 people.

There are no toilets or running water in the homes of Korogocho ??? an informal settlement in Nairobi that a group of participants from the International Conference on Urban Health (ICUH) visited today. The urban tours were spearheaded by ISUH president, Dr. Jean-Christophe Fotso. “If we were to bring professionals all the way to Africa to discuss urban health, we would be remiss to pass up the opportunity to have people see for themselves the impact of

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dire poverty on urban health,” said Fotso.

Proper sanitation is just one of many basic services lacking for the urban population of Korogocho. “Sanitation is critical for good health, but seriously, you have to think of what people need today,” said the Hon. Elizabeth Ongoro Masha, Member of Parliament, of Kasarani and our charismatic tour guide for the day. “Before you talk of a toilet, you must ask if they have eaten today. Because if there is no food in their stomach, for what will they need a toilet?”

Enthusiastic crowds spontaneously gather to greet the Hon. Elizabeth Ongoro Masha. Photo by Amy Hart

Ongoro understands the needs of the people she represents and her popularity is clear as spontaneous parades of residents greet her unannounced visit with hugs and kisses and lively music.

Why was the visit unannounced? “Because we could never get through the streets if they knew we were coming,” Ongoro clarified. “Imagine thousands of people on these roads ??? we would never get through.”

As it was, the tour bus could barely squeeze past a narrow passage between a pole and a pile of rocks in the road.

But the crowd was happy to jump up and make way for their elected representative. The demand for Ongoro’s attention does not stop at the edge of Korogocho ??? she is a Member of Parliament (MP) representing three additional regions, bringing the count of her constituents to approximately one million people. To provide some type of support for one million severely impoverished people cannot be easy ??? and her car was mauled by desperate hands reaching out to her with the hope of getting a small amount of money to get their laboring wife or dying mother to a hospital. The men were tireless in their pursuit as they clutched on to the roof of her moving car and continued their pleas even as we careened through the bumpy roads of the settlement.

ICUH visitors meet children of Karari. Photo by Amy Hart

It cannot be easy to try to answer all of their needs, but Ongoro has set clear priorities and has employed their help to bring projects to fruition. “I don’t ever hire outside contractors. We hire people who live right here to do the work, that way they take pride in and ownership of the project, so it becomes sustainable. And it costs a lot less money than paying big contractors,” says Ongoro, “so we can stretch what limited funds we have quite a bit further.”

Ongoro is strategic with her Constituency Development Funds (CDF), an allotment of money that allows each MP to implement projects to serve the constituents in their region. Ongoro brought us to three projects today; they were all works in progress, but her vision was clear ??? empower the people and help them build a viable, secure lifestyle.

“When you talk of ‘security’ issues you are really talking of insecurity. When people become insecure, and they are caged into small cramped unsanitary quarters, the entire situation becomes very insecure,” said Ongoro.

Some participants were moved to tears by stories Ongoro shared. Photo by Amy Hart

Woman’s Birth Center. The Birth Center is designed to provide basic services for birthing mothers and their newborn infants. Presently, women give birth at home. Now consider giving birth in a leaky tin roofed shack with no electricity or running water and streams of human waste running over the dirt floor during the rainy season. The rates of maternal mortality are off the charts here and newborn babies stand little chance of being protected from life-threatening diseases in the first days of their lives.

The Women’s Birth Center is Ongoro’s answer to this serious problem. When it is finished, women will be able to come and give birth in a clean setting with lights and running water and a professional birth attendant. Newborn babies will be looked after and the woman will be instructed on breastfeeding, child health, hygiene and nutrition.

“Nutrition is a major concern ,” says Ongoro. “Medicines are great, but basic nutrition makes the most difference.” Food scarcity and hunger are rampant throughout the community where it is common to earn just 50 shillings (about 70 cents) per day selling vegetables or used clothing.

Therefore, the Birth Center will also serve meals to infants and children under the age of five. “I have found that when we just send food home with the women to the household, the food generally gets consumed by hungry adults and very little is left for the children. So the Birth Center will also be a place where children can come and get a meal,” says Ongoro.

By the middle of the day many of the conference participants were moved to tears. “You can see the pictures or the news clips on TV, but you cannot imagine the poverty, the real poverty, until you are actually here,” said a participant from Toronto. “It is overwhelming,” as she turned away to wipe her eyes. “If westerners saw this face to face???it simply wouldn’t be allowed to continue.”

According to Ongoro, the key to breaking the cycle of poverty is empowering the people and providing them with an opportunity to develop the skills they need to earn a living. To this end she brought us to a second project.

The Youth Resource Center will provide training to young men and women ??? hopefully sooner rather than later, as far as the 4,500 eager applicants are concerned. The barren concrete building will eventually be equipped and staffed to train mechanics, carpenters, drivers, chefs, tailors and computer technologists.

“This Resource Center is aimed at providing training not so they can get jobs downtown, but so that people can sell their services and earn a decent living,” said Ongoro. “From this they can start to build a life for themselves.”

Design model for Karari Boarding School for Girls. Photo by Amy Hart

Education and training isn’t just for young adults, Ongoro is also thinking of the most vulnerable population.

The Karari Boarding School for Girls will educate, house ??? and protect ??? girls during their primary school years. Not only are girls the least likely to get educated, they are the most likely to be victims of violent attacks.

According to Ongoro, there are daily instances of rape. “But not just of women ??? girls who are very young are also raped. Girls under ten ??? there was even a two-year-old raped recently,” said Ongoro to the stunned crowd. “And now they have come to murder the girls afterwards so that they cannot be identified for the rape.”

Unthinkable. Why rape such a young girl? Why?

“You have to understand, the circumstances of the men who commit these horrible crimes,” explained Ongoro. “They have been completely demoralized. They are unemployed and impoverished, they cannot get a home, they cannot attract a wife, they feel the system is against them and they are angry. They start drinking and doing drugs, because they have nothing else to do with their lives. And some of them turn into monsters and commit these horrible crimes. It is out of anger.”

Boy with water buckets. Photo by Amy Hart

The men working on the school project gave credence to Ongoro’s approach. “She hired a ‘crew of thugs’ to do the construction on one of the buildings in the area. There was no crime when those guys were working! And I tell you ??? normally, those are the guys who vandalize new projects and take all the materials. But this time, they protected it. And even now ??? if they see one nail is loose they go and get their hammer and fix that nail.”

The visitors expressed a great deal of admiration for her leadership and bravery, but some of them challenged Ongoro as well. “What about birth control?” asked one of the participants from India.

“Birth control is great, but in this situation it is considered a luxury. It is not necessary to getting through today. When a woman has too many mouths to feed, and she’s just been evicted from her squatter shack by the police, how can she think of finding her birth control pills!?” said Ongoro. “You have to think of what they need today. Then you can start working on tomorrow.”

Food security and basic nutrition. Training and employment. Education and protection of young girls. Safe birth. Secure housing. Clean affordable water. Toilets. “These are the kind of things that must be attended to ??? actively attended to ??? when you talk of urban health,” said Ongoro. “It is not just a pill you can take. That would be simple.”

The ICUH will continue throughout the week at the Kenyatta International Conference Center. www.icuh2009.org

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The 2009 ICUH conference is sponsored by Rockefeller Foundation, Bill and Melinda Gates Foundation, The MacArthur Foundation, USAID, The Wellcome Trust, The National Institute on Drug Abuse, and The World Health Organization.

The International Society on Urban Health (ISUH) is an association of researchers, scholars and professionals from various disciplines and areas of the world who study the health effects of urban environments and urbanization. The goals of ISUH are to encourage research, interventions and program evaluations that lead to healthier cities in the 21st century.

The New York Academy of Medicine (NYAM) is an independent organization that addresses the health challenges facing the world’s urban populations through interdisciplinary approaches to innovative research, education, community engagement and policy leadership. (www.NYAM.org)

Photo Essay by Amy Hart, October 20, 2009.

Posted on October 21, 2009

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